Volume 106, Issue 8 (December 2007)

Focus On… Empowering the Patient

Partnerships take many forms. In business, partners share profits as well as losses. In productive therapeutic relationships, counselors exhibit empathy, insight, and acceptance without judgment, and clients are open to constructive feedback. In successful marriages, partners consider each other’s needs, working together to sustain and deepen trust. What makes a successful doctor-patient partnership?

What health care professional doesn’t believe in patient-centered care? The term alone resonates with all of us, whether working in a hospital, clinic, or other health facility, with patients as the foci of our attention. Yet when the various definitions of “patient-centered care” are examined carefully, and our own practice patterns are compared to these standards, many of us come up short.

The Empowered Consumer? The future health care consumer is characterized as engaged, activated, adherent, self-managed, vigilant, and empowered; a transformation from the passive role of the traditional patient.

The day of the doctor and the nurse telling the patient what to do is over. Shared decision making is the new model. Patients often come into the health care setting with copious amounts of information related to their suspected or actual diagnosis. Although seen as challenging at times, these patients are the fortunate ones. They believe they have identified their problem, they feel good about what they know, and they are planning to remain as healthy as possible. The health care professional then needs to assess the beliefs held by the patient and together they decide the direction that will send the patient to the road to recovery.

Wisconsin is a leader in fostering partnerships to improve health care quality. Great strides can be made when physicians, nurses, patients, consumers, community leaders, employers, and insurers work together in collaborative efforts. No single group or profession can improve health care without the support of others. Collaborative approaches help health care professionals deliver better care and patients make better choices.

Economic, demographic, technologic, political, and cultural forces are converging and few in health care are ready. There has never been a time when physician engagement is more important and widespread mobilization is required. Medical societies’ political and legal advocacy remains critically important. However, these efforts, while necessary, are nsufficient. Medicine is confronted by changes of unprecedented magnitude that call every physician to action–but what action?

Editorials

When I became CEO of the Wisconsin Medical Society in 2005, one of our first accomplishments as an organization was the completion and implementation of a strategic plan focused on ensuring access to high quality, cost-efficient care for all patients in Wisconsin. To ensure our success in achieving this mission, we also defined several key initiatives, which include “lead the practice of patient-centered care in Wisconsin” and “protect Wisconsin’s favorable medical liability climate.”

Fundamental to sound policy analysis is the distinction between public goods and private goods. This is a distinction that should be made when considering the privatization of Wisconsin Blue Cross Blue Shield.

Review Articles

Wisconsin Blue Cross was chartered in 1939 as a “charitable and benevolent corporation” to cover hospitalization costs at a time when most Americans did not have health insurance. In order to promote the protection that insurance afforded, the Wisconsin legislature exempted the company from most state and local taxes. During World War II, the federal government created tax deductions for both employers and employees, which created new demand for health insurance. The company extended its coverage to physicians’ services and, as Blue Cross Blue Shield United of Wisconsin (BCBSUW), became the state’s largest health insurer. In 1965, when Medicare and Medicaid further extended health coverage to the elderly, disabled, and indigent, the company took on the additional activity of administering those benefits on behalf of the government. The surge in demand for health care led to inflation in health costs in the 1970s.
Many in the insurance industry and government felt this inflation could be controlled through the extension of market competition among insurers. They therefore proposed abandoning their tax exemptions in exchange for the right to operate as for-profit corporations. As a condition of this transformation, the state government required that BCBSUW create charitable foundations to benefit medical education and public health. After privatization, however, the for-profit successors of BCBSUW failed to control both medical costs and company administrative expenses. A substantial share of the profits went to their executives.

Original Research

As a result of low dietary intake and sun avoidance, low vitamin D status is endemic in Wisconsin. In a convenience sample of postmenopausal Wisconsin residents, 59% had suboptimal D status. Only recently, the medical community has begun to appreciate that low vitamin D status underlies multiple deleterious health consequences including skeletal fragility, muscle weakness, and a potential multitude of non-skeletal morbidities.

We evaluated journals kept by primary care medical students to identify prominent themes and
determine change or constancy in themes over time. We looked at third-year medical students participating in a required primary care clerkship in a university-affiliated, community-based family medicine residency program with a rural catchment area.

The Wisconsin Medical Society, Wisconsin Hospital Association, MetaStar, Wisconsin Collaborative for Healthcare Quality, and the Wisconsin Health Information Organization partnered on the 2007 Wisconsin Quality and Safety Forum held October 22-23 in Waukesha. A highlight of the forum was the showcase of quality and safety projects from health care organizations around the state. We are pleased to publish shortened versions of these projects in this issue of the Wisconsin Medical Journal.

Case Reports

The differential diagnosis for hypophosphatemia is long, and involves complex, overlapping physiological systems. Practitioners are often guilty, however, of simply supplementing phosphate without fully investigating the etiology of the problem. The purpose of this case presentation is to illustrate a case of spurious hypophosphatemia that initially led to unnecessary phosphate replacement in a woman with undiagnosed multiple myeloma.

Patient safety traditionally has been focused on improving patient safety by focusing on the actions of health care professionals rather than through the empowerment or education of patients. In July 2005, a new organization was formed, choosing as its name “Safe Care Wisconsin: Partners for Advancing Health Care Safety.” The purpose of the group is to help health care consumers to be safer as they engage with health care professionals.

Your Profession

The Stark Law (often referred to as the Physician Self-Referral Law) prohibits physicians from referring Medicare patients for certain designated health services (DHS) to an entity with which the physician or a member of the physician’s immediate family has a financial relationship (ownership or compensation)— unless an exception applies and prohibits an entity from filing claims with Medicare for those referred services. Penalties for violating the Stark Law include denial of payment for the service, civil monetary penalties, or even the possibility of being excluded from the Medicare or Medicaid programs.

Your Society

The 2008 Annual Meeting of the Wisconsin Medical Society will convene Friday, April 11, 2008, at the Monona Terrace Convention Center in Madison. The deadline for receipt of resolutions, so they can be included in the House of Delegates handbook, is Monday, February 11, 2008. Resolutions must be submitted, in proper form, to the CEO’s office no later than 2 months prior to the opening session of the House of Delegates.

It was 1998 when Patrick Wolf, DO, of Marshfield Clinic, realized his dream of opening a free medical clinic. As an urgent care physician, he knew the health care system was not adequately serving everyone in need. But it wasn’t until after he and his colleagues actually began running the Free Clinic that they realized it was serving more than the uninsured, but the underinsured, as well.